声触诊组织量化联合细针抽吸活检对TI-RADS 4类甲状腺结节的诊断价值

Evaluation of virtual touch tissue quantification combined with fine-needle aspiration biopsy for diagnosis of thyroid nodules TI-RADS class 4

目的:探讨声触诊组织量化(VTQ)联合超声引导细针穿刺活检(US-FNAB)对TI-RADS 4类甲状腺结节的诊断价值。方法:回顾性分析病理检查的191例甲状腺结节病人共200个TI-RADS 4类结节病灶,术前均接受VTQ及US-FNAB检查。VTQ以横向剪切波速度(SWV)来表示甲状腺结节硬度,运用ROC曲线找出SWV最佳截断界值。用US-FNAB细胞学结果判定结节性质;将VTQ、US-FNAB及VTQ联合US-FNAB诊断结果分别与病理检查结果进行对照研究,比较各自的诊断效果。结果:经手术病理检查良性结节58个,恶性结节142个。甲状腺良、恶性结节SWV均值差异有统计学意义(P<0.001)。ROC曲线确定SWV最佳截断界值为3.0025。US-FNAB诊断灵敏度90.14%,特异度86.21%。VTQ、US-FNAB、VTQ联合US-FNAB对应的AUC分别为0.778、0.873、0.879,VTQ联合US-FNAB、USFNAB与VTQ比较诊断效果差异有统计学意义(P<0.05),而VTQ联合US-FNAB与US-FNAB比较差异无统计学意义(P>0.05)。结论:VTQ可用于定量评估甲状腺结节病灶硬度,有一定的鉴别诊断价值。US-FNAB是术前判断甲状腺结节良、恶性的重要手段。两者联合应用有较高的诊断价值。

Objective To analyze virtual touch tissue quantification（VTQ） combined with ultrasound-guided fineneedle aspiration biopsy（US-FNAB） for diagnosis of thyroid nodules thyroid imaging reporting and data system class 4（TI-RADS 4）. Methods A total of 191 patients with 200 thyroid nodules TI-RADS class 4 received preoperative examination of VTQ and US-FNAB were retrospectively analyzed. Transverse shear wave velocity（SWV） was measured to reflect VTQ indicating the stiffness of the nodules. Receiver operating characteristic（ROC） curve was used to find the best cut-off point of SWV. Thyroid nodules was examined by cytological US-FNAB. The results using VTQ method, US-FNAB method and VTQ combined with US-FNAB method to diagnose the thyroid nodules TI-RADS class 4 were compared. Results There were 58 benign nodules and 142 malignant nodules based on postoperative pathological diagnosis. A significant difference in the mean value of SWV was found between benign and malignant thyroid nodules（P〈0.001）. The best cut-off point of SWV was at 3.0025 according to ROC curve. The sensitivity and specificity of US-FNAB diagnosis were 90.14% and86.21% respectively. The AUC of VTQ, US-FNAB and VTQ combined with US-FNAB were 0.778, 0.873, 0.879,respectively. A difference in diagnostic performance was present when using the method VTQ combined with US-FNAB or US-FNAB compared with using the method VTQ only（P〈0.05） while no difference between VTQ combined with US-FNAB and US- FNAB（ P〉 0. 05）. Conclusions VTQ provides quantitative information on the stiffness of nodules in the differentiation between benign and malignant nodules. US-FNAB is an important examination of preoperative determination. US-FNAB combined with VTQ might be highly valuable in diagnosis of thyroid nodules TI-RADS class 4.